CONSERVATIVE TREATMENT USING A METHOTREXATE-LIPIODOL EMULSION CONTAINING NONIONIC CONTRAST-MEDIUM FOR A CERVICAL ECTOPIC PREGNANCY

We present a case in which a viable cervical pregnancy was successfull y treated with preservation of the uterus, A 26 year old female presen ted with a 6 week cervical pregnancy with acute moderate bleeding, On the day of admission the patient underwent embolization of the descend ing uterine artery to decrease the bleeding, The following day, 4 mEq potassium chloride and methotrexate (MTX)(1 mg/kg) dissolved in saline was injected into the amniotic cavity using transvaginal sonographic guidance, The fetal heart beat ceased; however, the urinary beta-human chorionic gonadotrophin (HCG) concentration increased and the gestati onal sac size also increased, After a second injection of an emulsion of MTX (1 mg/kg) dissolved in a non-ionic contrast medium, iopamidol a nd lipiodol, the beta HCG concentration in the urine began to decrease , After a third injection with the same emulsion, the cervical mass be came necrotic, The beta HCG concentrations in the urine and serum were undetectable and the external cervix returned to normal 44 days after admission, No vaginal bleeding or significant side effects of MTX wer e observed throughout the treatment, An in-vitro dissolution test reve aled that the dissolution rate of MTX was slower from MTX-lipiodol-iop amidol with sonication than without sonication, The present study indi cates that use of an MTX emulsion enables slow release of MTX and may be applicable for conservative treatment of ectopic pregnancies, inclu ding cervical pregnancy.